<?php include 'header.php'; ?>
<head>
<script language="JavaScript">
    function setFocus(num){
      if(num == 1)
	  {
        document.inquiry.first_name.focus();
      }
	  else if(num == 2)
	  {
        document.inquiry.last_name.focus();
      }
      else if(num == 3)
	  {
        document.inquiry.address.focus();
      }
      else if(num == 4)
	  {
        document.inquiry.city.focus();
      }
      else if(num == 5)
	  {
        document.inquiry.province.focus();
      }
      else if(num == 6)
	  {
        document.inquiry.postal_code.focus();
      }
      else if(num == 7)
	  {
        document.inquiry.email.focus();
      }
      else if(num == 8)
	  {
        document.inquiry.phone_number.focus();
      }
      else if(num == 9)
	  {
        document.inquiry.alt_phone_number.focus();
      }
    }
</script>

<style type="text/css">

#lefthead
{
font-size:100%;
padding-left:10px;
}
#left
{
font-size:110%;
padding-left:10px;
}
#right
{
padding-right:5px;
font-size:70%;
}
#table_padding1
{
width:95%;
padding:25px 0px 30px 25px;
margin-top:-40px;
margin-left:-30px;
margin-bottom:20px;
background-color:#F0F0F0;
border-width:1px 1px 1px 1px;
//border-style: solid;
//border-color:#e56506;
}
#table_padding2
{
padding:5px;
margin-bottom:0px;
background-color:#F0F0F0;
border-width:0px 1px 0px 1px;
border-style: solid;
border-color:#A80000;
}
#table_padding3
{
padding:5px;
margin-bottom:30px;
background-color:#F0F0F0;
border-width:0px 1px 1px 1px;
border-style: solid;
border-color:#A80000;
}
td
{
font-family:"Lucida Grande",Arial,sans-serif;
font-weight:lighter;
font-size:12;
}
#font
{
color:#e56506;
font-family:"Lucida Grande",Arial,sans-serif;
font-weight:normal;
}

#field {
font: 11px Verdana, Sans-Serif;
width: 300px;
}

#button {
font: 11px Verdana, Sans-Serif;
width: 60px;
}

textarea {
font: 11px Verdana, Sans-Serif;
width: 300px;
height: 120px;
}

#warning
{
padding:5px;
margin-bottom:0px;
background-color:#E77471;
border-width:1px;
border-style: solid;
border-color:#A80000;
}

#section
{
font-size:"20px";
font-family:"Lucida Grande",Arial,sans-serif;
font-weight:normal;
}



#font
{
align:left;
color:#e56506; //A80000;
font-family:"Lucida Grande",Arial,sans-serif;
font-weight:normal;
}

#table_padding
{
padding:25px 25px 25px 150px;
margin-bottom:30px;
background-color: #F0F0F0;
//border-style:solid;
//border-color:#900000 #A80000;
border:1px solid #e56506;
}

#topcaption
{
width:100%;
padding:25px 5px 10px 25px;

//padding:30px 0px 15px 0px;
}
span.headline 
{
width:50px;
font-weight:bold;
font-size:110%;
color:#e56506;
}

#demo
{
width: 300px;
}
</style>
<title>Load Express - Pickup</title>
	<link type="text/css" href="<?php echo base_url(); ?>themes/base/jquery.ui.all.css" rel="stylesheet" />	
	<script type="text/javascript" src="<?php echo base_url()."script/"; ?>jquery-1.4.2.js"></script>
	<script type="text/javascript" src="<?php echo base_url()."script/"; ?>jquery.ui.core.js"></script>
	<script type="text/javascript" src="<?php echo base_url()."script/"; ?>jquery.ui.widget.js"></script>
	<script type="text/javascript" src="<?php echo base_url()."script/"; ?>jquery.ui.datepicker.js"></script>
	<link type="text/css" href="<?php echo base_url()."css/"; ?>demos.css" rel="stylesheet" />
<script type="text/javascript">
$(function() {
	$("#datepicker").datepicker();
});
</script>
</head>
		<div class="rightside">
<!--
				<table id="topcaption" align="left">
					<tr>
						<td>
-->
							<?php if(strcmp($warning,"")!=0) {?>
							<p id="warning"><?php echo $warning; ?></p>
							<?php }?>
<!--						</td>
					</tr>
					<tr>
						<td>
							<h2 id="font">Request a Call<br></h2>	
						</td>
					</tr>
				</table>
-->
				<h2 id="font">Request a Call<br></h2>
				<?php 
					$comment = array(
					  'name'        => 'other_comment',
					  'id'           => 'username',
					  'value'       => $other_comment,
					  'style'		=> 	'overflow: hidden',
					  'rows'   		=> '8',
					  'cols'      => '35'
					);
					$shipment_destination = array(
					  'name'        => 'shipment_destination',
					  'id'           => 'username',
					  'value'       => $shipdest_comment,
					  'style'		=> 	'overflow: hidden',
					  'rows'   		=> '8',
					  'cols'      => '10'
					);
					$MAX_SIZE=43;
					echo form_open('quotation'); 
				?>
				<center>
				<table id="table_padding1" align="center" width="98%">
					<tr>
						<td id="lefthead" colspan="2" align=left><span class="headline"><?php echo "Requesting Party<br />\n <br />\n"; ?></span></td>
					</tr>
					<tr>
						<td id="left" align=left width=30%><?php	echo "Name"; ?><font color="#A80000">*</font></td>
						<td align=right width=2%><?php	echo ":"; ?></td>
						<td align=left width=68%><input id="field" size=<?php	echo $MAX_SIZE; ?> name="requester_name" type="text" value="<?php echo $requester_name;?>" onClick="setFocus(1)"></td>
					</tr>
<!--
					<tr>
						<td id="left" align=left width=25%><?php	echo "Company Name"; ?><font color="#A80000">*</font></td>
						<td align=right width=5%><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="reqesting_company_name" type="text" value="<?php echo $requesting_comp_name;?>" onClick="setFocus(1)"></td>
					</tr>
-->
					<tr>
						<td id="left" align=left><?php	echo "Email";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="email" type="text" value="<?php echo $email;?>" onClick="setFocus(7)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Phone";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="your_phone_number" type="text" value="<?php echo $your_number;?>" onClick="setFocus(8)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "You are the";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<br />
						<td id="right" align=left><input type="radio" name="requester_designation" value="Shipper" >Shipper 
												  <input type="radio" name="requester_designation" value="Consignee" >Consignee 
												  <input type="radio" name="requester_designation" value="Third_Party" >Third Party (Bill To Address)
						</td>
					</tr>
					<tr>
					<div class="demo">
						<td id="left" align=left><?php	echo "Requested Pickup Date";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="datepicker" size=<?php	echo $MAX_SIZE; ?> name="req_pickup_date" type="text" value="<?php echo $pickup_date; ?>" onClick="setFocus(7)"></td>	
					<!--					<td id="right" align=left><input id="datepicker" size=<?php	echo $MAX_SIZE; ?> name="req_pickup_date" type="text" value="<?php if($pickup_date) echo $pickup_date; else echo date("Y/m/d");?>" onClick="setFocus(7)"></td>	-->
					</div>
					</tr>
					<tr>
						<td></td>
						<td></td>
						<td id="right" align=left>(year/month/date)</td>
					</tr>
					<tr>
						<td  id="lefthead" colspan="2" align=left><span class="headline"><?php echo "<br />\n <br />\nPickup Location<br />\n <br />\n"; ?></span></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Contact Name";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="pickup_contact_name" type="text" value="<?php echo $pickup_contact_name;?>" onClick="setFocus(3)"></td>
					</tr>
<!--
					<tr>
						<td id="left" align=left><?php	echo "Country";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left>
							<SELECT NAME="pickup_country">
								<OPTION VALUE="">
								<OPTION VALUE="Canada">Canada
								<OPTION VALUE="USA">USA
							</SELECT>
						</td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Province/State";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><?php	echo form_dropdown('pickup_province_list', $province_list);  ?></td>
					</tr>
-->
					<tr>
						<td id="left" align=left><?php	echo "City";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><?php	echo form_dropdown('pickup_city_list', $city_list);  ?></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Street Address";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="pickup_address" type="text" value="<?php echo $pickup_address;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Postal/Zip Code";  ?><font color="#A80000"></font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="pickup_p_code" type="text" value="<?php echo $pickup_p_code;?>" onClick="setFocus(5)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Fax";  ?><font color="#A80000"></font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="pickup_fax" type="text" value="<?php echo $pickup_fax;?>" onClick="setFocus(6)"></td>
					</tr> 
					<tr>
						<td id="left" align=left><?php	echo "Ready for Pickup";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left>
							<table>
								<tr>
									<td>
										<SELECT NAME="pickup_time">
											<OPTION VALUE="1:00">1:00
											<OPTION VALUE="1:30">1:30
											<OPTION VALUE="2:00">2:00
											<OPTION VALUE="2:30">2:30
											<OPTION VALUE="3:00">3:00
											<OPTION VALUE="3:30">3:30
											<OPTION VALUE="4:00">4:00
											<OPTION VALUE="4:30">4:30
											<OPTION VALUE="5:00">5:00
											<OPTION VALUE="5:30">5:30
											<OPTION VALUE="6:00">6:00
											<OPTION VALUE="6:30">6:30
											<OPTION VALUE="7:00">7:00
											<OPTION VALUE="7:30">7:30
											<OPTION VALUE="8:00">8:00
											<OPTION VALUE="8:30">8:30
											<OPTION VALUE="9:00">9:00
											<OPTION VALUE="9:30">9:30
											<OPTION VALUE="10:00">10:00
											<OPTION VALUE="10:30">10:30
											<OPTION VALUE="11:00">11:00
											<OPTION VALUE="11:30">11:30
											<OPTION VALUE="12:00">12:00
											<OPTION VALUE="12:30">12:30
										</SELECT>
									</td>
									<td id="right" align="left"><input type="radio" name="pickup_time_period" value="am" >am 
																<input type="radio" name="pickup_time_period" value="pm" >pm
									</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Company";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="pickup_company_name" type="text" value="<?php echo $pickup_company_name;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Phone number";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="pickup_phone_number" type="text" value="<?php echo $pickup_phone_number;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Dock closing Time";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left>
							<table>
								<tr>
									<td>
										<SELECT NAME="dock_closed_time">
											<OPTION VALUE="1:00">1:00
											<OPTION VALUE="1:30">1:30
											<OPTION VALUE="2:00">2:00
											<OPTION VALUE="2:30">2:30
											<OPTION VALUE="3:00">3:00
											<OPTION VALUE="3:30">3:30
											<OPTION VALUE="4:00">4:00
											<OPTION VALUE="4:30">4:30
											<OPTION VALUE="5:00">5:00
											<OPTION VALUE="5:30">5:30
											<OPTION VALUE="6:00">6:00
											<OPTION VALUE="6:30">6:30
											<OPTION VALUE="7:00">7:00
											<OPTION VALUE="7:30">7:30
											<OPTION VALUE="8:00">8:00
											<OPTION VALUE="8:30">8:30
											<OPTION VALUE="9:00">9:00
											<OPTION VALUE="9:30">9:30
											<OPTION VALUE="10:00">10:00
											<OPTION VALUE="10:30">10:30
											<OPTION VALUE="11:00">11:00
											<OPTION VALUE="11:30">11:30
											<OPTION VALUE="12:00">12:00
											<OPTION VALUE="12:30">12:30
										</SELECT>
									</td>
									<td id="right" align="left"><input type="radio" name="dock_closed_time_period" value="am" >am 
																<input type="radio" name="dock_closed_time_period" value="pm" >pm
									</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr>
						<td  id="lefthead" colspan="2" align=left><span class="headline"><?php echo "<br />\n <br />\nDrop off Destination<br />\n <br />\n"; ?></span></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Contact Name";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="destination_contact_name" type="text" value="<?php echo $destination_contact_name;?>" onClick="setFocus(3)"></td>
					</tr>
<!--
					<tr>
						<td id="left" align=left><?php	echo "Country";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left>
							<SELECT NAME="destination_country">
								<OPTION VALUE="">
								<OPTION VALUE="c1">Canada
								<OPTION VALUE="c2">USA
							</SELECT>
						</td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Province/State";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><?php	echo form_dropdown('destination_province_list', $province_list);  ?></td>
					</tr>
-->
					<tr>
						<td id="left" align=left><?php	echo "City";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><?php	echo form_dropdown('destination_city_list', $city_list);  ?></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Street Address";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="destination_address" type="text" value="<?php echo $destination_address;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Postal/Zip Code";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="destination_p_code" type="text" value="<?php echo $destination_p_code;?>" onClick="setFocus(5)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Fax";  ?><font color="#A80000"></font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td id="right" align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="destination_fax" type="text" value="<?php echo $destination_fax;?>" onClick="setFocus(6)"></td>
					</tr> 
					<tr>
						<td id="left" align=left><?php	echo "Company";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="destination_company_name" type="text" value="<?php echo $pickup_company_name;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Phone number";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="destination_phone_number" type="text" value="<?php echo $pickup_phone_number;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="lefthead" colspan="2" align=left><span class="headline"><?php echo "<br />\n <br />\nShipment Information<br />\n <br />\n"; ?></span></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Description of Goods";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="goods_description" type="text" value="<?php echo $goods_description;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Total Pieces";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="total_pieces" type="text" value="<?php echo $total_pieces;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Total Weight";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left>
							<table>
								<tr>
									<td align=left><input size="10px" name="total_weight" type="text" value="<?php echo $total_weight;?>" onClick="setFocus(3)"></td>
									<td align=left>
										<SELECT NAME="weight_unit">
											<OPTION VALUE="lbs">lbs.
											<OPTION VALUE="kg">kg
										</SELECT>
									</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr>
						<td id="left" align=left><?php	echo "Hazardous Goods";  ?><font color="#A80000">*</font></td>
						<td align=right><?php	echo ":"; ?></td>
						<td align=left>	<SELECT NAME="is_hazardous">
											<OPTION VALUE="h1">yes
											<OPTION VALUE="h2">no
										</SELECT>
						</td>
					</tr>
					<tr>
						<td id="left" valign="top" align=left><?php	echo "Special Handling Instructions";  ?><font color="#A80000">*</font></td>
						<td align=right valign="top"><?php	echo ":"; ?></td>
						<td align=left><input id="field" size=<?php	echo $MAX_SIZE; ?> name="hand_inst" type="text" value="<?php echo $hand_inst;?>" onClick="setFocus(3)"></td>
					</tr>
					<tr>
						<td id="left" valign="top" align=left><?php	echo "Shipment Destination";  ?><font color="#A80000">*</font></td>
						<td align=right valign="top"><?php	echo ":"; ?></td>
						<td id="right" align=left><?php	echo form_textarea($shipment_destination);  ?></td>
					</tr>
					<tr>
						<td id="left" valign="top" align=left><?php	echo "Other Comment";  ?><font color="#A80000">*</font></td>
						<td align=right valign="top"><?php	echo ":"; ?></td>
						<td id="right" align=left><?php	echo form_textarea($comment);  ?></td>
					</tr>
					<tr>
						<td></td><td></td>
						<td align=left>
										<input id="button" type="submit" name="submit" value="Submit" />
										<input id="button" type="submit" name="reset" value="Reset" />
						</td>
					</tr>
				</table>
				</center>
				<?php	echo form_close();  ?>
				<br /><br /><br />
		</div>


<?php include 'footer.php'; ?>